Dynamics and features of transmission clusters of HIV-1 subtypes in the state of São Paulo, Brazil.

Background: Molecular epidemiology techniques allow us to track the HIV-1 transmission dynamics. Herein, we combined genetic, clinical and epidemiological data collected during routine clinical treatment to evaluate the dynamics and characteristics of transmission clusters of the most prevalent HIV-1 subtypes in the state of São Paulo, Brazil. Methods: This was a cross-sectional study conducted with 2,518 persons living with HIV (PLWH) from 53 cities in São Paulo state between Jan 2004 to Feb 2015. The phylogenetic tree of protease/reverse transcriptase (PR/RT) regions was reconstructed by PhyML and ClusterPicker used to infer the transmission clusters based on Shimodaira-Hasegawa (SH) greater than 90% (phylogenetic support) and genetic distance less than 6%. Results: Of a total of 2,518 sequences, 2,260 were pure subtypes at the PR/RT region, being B (88%), F1 (8.1%), and C (4%). About 21.2% were naïve with a transmitted drug resistance (TDR) rate of 11.8%. A total of 414 (18.3%) of the sequences clustered. These clusters were less evident in subtype B (17.7%) and F1 (15.1%) than in subtype C (40.2%). Clustered sequences were from PLWH at least 5 years younger than non-clustered among subtypes B (p < 0.001) and C (p = 0.037). Men who have sex with men (MSM) predominated the cluster in subtype B (51%), C (85.7%), and F1 (63.6%; p < 0.05). The TDR rate in clustered patients was 15.4, 13.6, and 3.1% for subtypes B, F1, and C, respectively. Most of the infections in subtypes B (80%), C (64%), and F1 (59%) occurred within the state of São Paulo. The metropolitan area of São Paulo presented a high level of endogenous clustering for subtypes B and C. The São Paulo city had 46% endogenous clusters of subtype C. Conclusion: Our findings showed that MSM, antiretroviral therapy in Treatment-Naive (ART-naïve) patients, and HIV1-C, played an important role in the HIV epidemic in the São Paulo state. Further studies in transmission clusters are needed to guide the prevention intervention.

An overview of vinasse pollution in aquatic ecosystems in Brazil.

We review the negative impacts of vinasse, a byproduct of alcohol distillation, on Brazil's freshwater ecosystems. We found a total of 37 pollution events between the years 1935 and 2023, with this number almost certainly an underestimate due to underreporting and/or unassessed events. Pollution by vinasse occurred both through accidents (e.g., tank failure) and deliberately (i.e., opening of floodgates), although in many cases the causes remain undetermined. All pollution events caused fish kills, with some records reporting negative effects on other organisms as well (i.e., crustaceans and reptiles). Pollution by vinasse, and associated negative effects, was reported for 11 states, with a notable number of cases in São Paulo. Most cases of vinasse pollution and negative impacts on biodiversity were recorded in rivers, followed by streams and reservoirs. Some of the affected river systems harbour threatened freshwater fishes. Hydrological connectivity means that pollution could have propagated along watercourses. Given these consequences of vinasse pollution on biodiversity, ecosystem functioning and services, we recommend a number of remedial actions.

Air quality modeling in the metropolitan area of São Paulo, Brazil: A review.

Numerous studies have used air quality models to estimate pollutant concentrations in the Metropolitan Area of São Paulo (MASP) by using different inputs and assumptions. Our objectives are to summarize these studies, compare their performance, configurations, and inputs, and recommend areas of further research. We examined 29 air quality modeling studies that focused on ozone (O3) and fine particulate matter (PM2.5) performed over the MASP, published from 2001 to 2023. The California Institute of Technology airshed model (CIT) was the most used offline model, while the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem) was the most used online model. Because the main source of air pollution in the MASP is the vehicular fleet, it is commonly used as the only anthropogenic input emissions. Simulation periods were typically the end of winter and during spring, seasons with higher O3 and PM2.5 concentrations. Model performance for hourly ozone is good with half of the studies with Pearson correlation above 0.6 and root mean square error (RMSE) ranging from 7.7 to 27.1 ppb. Fewer studies modeled PM2.5 and their performance is not as good as ozone estimates. Lack of information on emission sources, pollutant measurements, and urban meteorology parameters is the main limitation to perform air quality modeling. Nevertheless, researchers have used measurement campaign data to update emission factors, estimate temporal emission profiles, and estimate volatile organic compounds (VOCs) and aerosol speciation. They also tested different emission spatial disaggregation approaches and transitioned to global meteorological reanalysis with a higher spatial resolution. Areas of research to explore are further evaluation of models' physics and chemical configurations, the impact of climate change on air quality, the use of satellite data, data assimilation techniques, and using model results in health impact studies. This work provides an overview of advancements in air quality modeling within the MASP and offers practical approaches for modeling air quality in other South American cities with limited data, particularly those heavily impacted by vehicle emissions.

Air quality improvements from a transport modal change in the São Paulo megacity.

Air quality and urban mobility are complex socioenvironmental issues faced by megacities, particularly those in the Global South. Investments in efficient and inclusive public transport networks, as well as encouraging active transport modals, can mitigate both traffic congestion and air pollution, leading to improved quality of life. Few studies have integrated the potential effects of a well-developed rail network in influencing modal choice - from motorised to active transport - and their impacts on pollutant emission and air quality through dynamic air quality models. In the megacity of São Paulo, the expansion of the subway system has not achieved the planned targets, as intended by state government plans. This induces the question "What would have happened to air pollution if planned stations had been properly implemented?" which this paper aims to answer, through the increased adoption of cycling or walking to and from railway stations. We applied the WRF-Chem air quality model to model the effects of railway development in a megacity, focusing on criteria pollutants. Results show that the more investments there are in public transport, by expanding the metro system, the more expressive are the decreases in air pollution, and the farther these benefits spread out spatially. More intense reductions in pollutant concentrations are predicted to occur near the new stations' buffers, but citizens living far from the metro stations will also benefit from these improvements. Additionally, modal change from car to walking/cycling and subway in all trips within a radius of 1.3 km centered in existing and planned stations is expected to result in a decrease of 11.7 % in CO2eq vehicular emissions. Therefore, improvements in public transportation could help improving environmental and social justice, leading to better air quality and transport accessibility, decreasing public health problems and costs, while helping cities reach their GEE emissions reduction targets.

Effect of Photoperiod Duration on Flower Bud Differentiation and Related Gene Expression in Bougainvillea glabra 'Sao Paulo'.

BACKGROUND: Environmental conditions, such as photoperiod, affect the developmental response of plants; thus, plants have evolved molecular mechanisms to adapt to changes in photoperiod. In Bougainvillea spp., the mechanism of flower formation underlying flowering control techniques remains poorly understood, and the physiological changes that occur during flower bud formation and the expression of related genes are not yet fully understood. METHODS: In this study, we induced flowering of potted Bougainvillea glabra 'Sao Paulo' plants under light-control treatments and analyzed their effects on flowering time, number of flower buds, flowering quality, as well as quality of flower formation, which was analyzed using transcriptome sequencing. RESULTS: Light-control treatment effectively induced the rapid formation of flower buds and early flowering in B. glabra 'Sao Paulo', with the time of flower bud formation being 119 days earlier and the flowering period extended six days longer than those of the control plants. The light-control treatment caused the bracts to become smaller and lighter in color, while the number of flowers increased, and the neatness of flowering improved. Transcriptome sequencing of the apical buds identified 1235 differentially expressed genes (DEGs) related to the pathways of environmental adaptation, biosynthesis of other secondary metabolites, glycan biosynthesis and metabolism, and energy metabolism. DEGs related to gibberellin metabolism were analyzed, wherein five DEGs were identified between the control and treatment groups. Transcriptomic analysis revealed that the gibberellin regulatory pathway is linked to flowering. Specifically, GA and GID1 levels increased during this process, enhancing DELLA protein degradation. However, decreasing this protein's binding to CO did not halt FT upregulation, thereby advancing the flowering of B. glabra 'Sao Paulo'. CONCLUSIONS: The findings of our study have implications for future research on photoperiod and its role in controlling flowering timing of Bougainvillea spp.

Cross-continental comparative experiences of wastewater surveillance and a vision for the 21st century.

The COVID-19 pandemic has brought the epidemiological value of monitoring wastewater into sharp focus. The challenges of implementing and optimising wastewater monitoring vary significantly from one region to another, often due to the array of different wastewater systems around the globe, as well as the availability of resources to undertake the required analyses (e.g. laboratory infrastructure and expertise). Here we reflect on the local and shared challenges of implementing a SARS-CoV-2 monitoring programme in two geographically and socio-economically distinct regions, São Paulo state (Brazil) and Wales (UK), focusing on design, laboratory methods and data analysis, and identifying potential guiding principles for wastewater surveillance fit for the 21st century. Our results highlight the historical nature of region-specific challenges to the implementation of wastewater surveillance, including previous experience of using wastewater surveillance, stakeholders involved, and nature of wastewater infrastructure. Building on those challenges, we then highlight what an ideal programme would look like if restrictions such as resource were not a constraint. Finally, we demonstrate the value of bringing multidisciplinary skills and international networks together for effective wastewater surveillance.

Betacoronavirus Infection Outbreak, São Paulo, Brazil, Fall 2023.

We report a human coronavirus OC43 infection outbreak in hospitalized patients and healthcare workers in São Paulo, Brazil, occurring after SARS-CoV-2 cases disappeared. Infection was associated with healthcare workers in 5 (29.4%) patients. Routine surveillance including a respiratory virus panel can improve coronavirus detection in both healthcare professionals and patients.

Space-time clusters of cardiovascular mortality and the role of heatwaves and cold spells in the city of São Paulo, Brazil.

The effects extreme air temperature events are related with an increase in cardiovascular mortality among vulnerable groups worldwide. Therefore, we identify spatiotemporal mortality clusters associated with diseases of the cardiovascular system among people ≥ 65 years in São Paulo, from 2006 to 2015, and investigate whether high-risk mortality clusters occurred during or following extreme air temperature events. To detect the clusters, we used daily mortality data and a retrospective space-time scan analysis with a discrete Poisson model. Extreme air temperature events were defined by daily mean temperatures, below the 10th percentile for cold spells and above the 90th percentile for heatwaves, with two or more consecutive days. We found statistically significant high-risk mortality clusters located in the peripheral areas. The spatiotemporal clusters of risk areas for cardiovascular and ischemic heart disease occurred during or following cold spell events, whereas those for stroke and ischemic stroke events were related to heatwaves.

Estado, naturaleza: Instituciones de salud pública y atención médica en São Paulo entre los siglos XIX y XX / State, nature: Public health and medical care institutions in São Paulo between the 19th and 20th centuries

El artículo tiene como objetivo discutir la noción de naturaleza y salud pública durante la transición del Imperio a la República, específicamente en São Paulo, en la región sureste de Brasil. La calidad de la naturaleza de São Paulo fue repetidamente destacada, incluso después de la llegada de las grandes epidemias de fiebre amarilla y cólera a partir de 1850. Los principales cambios que tuvieron lugar en ese período fueron el aumento de la densidad democrática, la sustitución del trabajo esclavizado por trabajadores blancos y el cambio de régimen político. El objetivo aquí es discutir de manera panorámica el lugar de asistencia brindado por las Santas Casas de Misericordia en el cambio del siglo XIX al XX, en un período en que la atención a la salud todavía era la principal preocupación del gobierno. Veremos que, con la creación de los servicios sanitarios en el período republicano, las nociones de benignidad del clima y de las tierras de São Paulo se transformaron en la apreciación del avance sanitario y la calidad del marco civilizador de São Paulo.(AU)

The article aims to discuss the notion of nature and public health during the transition from Empire to Republic, specifically in São Paulo, in the southeastern region of Brazil. The quality of nature in São Paulo was repeatedly highlighted, even after the arrival of the great epidemics of yellow fever and cholera from 1850 onwards. The main changes that took place in that period were the increase in democratic density, the replacement of slave labour by white workers and the change of political regime. The aim here is to discuss in a panoramic way the place of assistance provided by the Santas Casas de Misericordia at the turn of the nineteenth to the twentieth century, in a period when health care was still the main concern of the government. We will see that, with the creation of health services in the republican period, notions of the benignity of the climate and lands of São Paulo were transformed in the appreciation of the sanitary progress and the quality of the civilising framework of São Paulo.(AU)

Dengue and climate changes: Increase of DENV-1 in São Paulo/Brazil - 2023.

Dengue is a vector borne disease caused by virus serotypes DENV-1, DENV-2, DENV-3, and DENV-4, representing a significant public health concern in the Region of the Americas (2,997,097 cases in 2023). This study explores the relationship between dengue incidence and climate changes in the city of São Paulo-Brazil. During the first semester of 2023, Brazil reported the highest number of dengue cases in Americas' Region. Our data reveals a correlation between the high temperature and rainfall season persistence and the extension of dengue incidence into the winter season. The findings highlight the importance of understanding the relationship between climate change and disease transmission patterns to develop effective strategies for prevention and control.

Characterization and finding the origin of off-flavor compounds in Nile tilapia cultured in net cages in hydroelectric reservoirs, São Paulo State, Brazil.

An increasing demand for fish products has led to an intensive aquaculture production in Brazil, and cultivation of fish constituted 860 × 103 tons in 2022, contributing to the 87% of total fish consumption. Nile tilapia constitutes almost half of the aquaculture production, and most tilapia farms use floating net cages. One of the major constraints of intensive fish production is production of off-flavors. Release of nutrients by the fish leads to deterioration of the water quality and stimulates growth of microorganisms, also including off-flavor producing species. The objective of this study was to determine levels of taste and odor compounds (geosmin, 2-MIB and a selection of volatile compounds) and their impact on the flavor quality of Nile tilapia produced in net cages in reservoirs in São Paulo State, Brazil. GC-MS analysis of fish and water from six different farms showed concentrations of geosmin in the water from 1 to 8 ng/L, while geosmin in fish flesh ranged from 40 to 750 ng/kg. The level of 2-MIB in water was 2 to 25 ng/L, and 0 to 800 ng/kg fish. The GC-MS analysis also revealed presence of more than 100 volatile organic compounds in the fish flesh, consisting of aldehydes, alcohols, benzene derivatives, hydrocarbons, ketones and few other compounds. Geosmin and 2-MIB related flavor notes were detected in all fish by a sensory panel, and a high correlation between the chemical and sensory analyses was found. The potential impact of the volatile organic compounds on the fish flavor is discussed. Analysis of the water quality in the reservoirs indicated that levels of geosmin and 2-MIB levels were highly influenced by the nutrient levels in the water.

Rescue method for a stranded giant manta ray (Mobula birostris).

An opportunistic rescue of a stranded 6 m giant manta ray off Ilha Comprida, in São Paulo, southeastern Brazil, revealed a new technique for returning large bodied mobulid rays to the water once beached. The technique, adapted from protocols to move stranded cetaceans, was modified to suit the dorso-ventrally compressed shape of mobulid rays and reduce damage to the animal while being pulled back into deeper water. The method and suggestions for its improvement have been described with the intention of assisting in the rescue of other stranded large mobulids.

Hospital Ophtálmico Internacional: Uma breve história (São Paulo, 1903-1914) / International ophthalmic hospital: a brief history (São Paulo, 1903-1914)

Neste artigo, a intenção é historicizar sobre o primeiro hospital de São Paulo dedicado a oftalmologia. O Hospital Ophtálmico Internacional foi fundado por italianos em 1903 em meio ao processo endêmico de tracoma no estado. Objetivamos compreender as circunstâncias históricas e as motivações políticas e econômicas que impulsionaram sua fundação, além de inferir sobre as relações entre as esferas públicas e privadas. Como o hospital foi criado inicialmente para atender imigrantes italianos que vieram trabalhar em São Paulo, articulamos, nesta história, as ações em saúde encetadas no Hospital com o processo de expansão da lavoura cafeeira e a imigração italiana. Em termos documentais, a pesquisa pautou-se em relatórios governamentais, matérias jornalísticas, teses e artigos científicos. A partir da historicidade da instituição, foi possível identificar a atuação da igreja católica na fundação do hospital, compreender os interesses econômicos dos fundadores do hospital ao defenderem a elite cafeeira paulista das denúncias de maus tratos dos seus trabalhadores e inferir sobre as motivações políticas na manutenção de uma instituição que primava atender enfermos de tracoma.(AU)

In this article, the intention is to historicize the first hospital in São Paulo dedicated to ophthalmology. The International Ophthalmic Hospital was founded by Italians in 1903 amid the endemic process of trachoma in the state. We aim to understand the circumstances stories and the political and economic motivations that drove its foundation, in addition to inferring the relations between the public and private spheres. As the hospital was initially created to serve Italian immigrants who came to work in São Paulo, we articulated, in this story, the health actions initiated in the Hospital with the process of expansion of coffee plantations and Italian immigration. In documentary terms, the research was based on government reports, journalistic articles, theses, and scientific articles. From the historicity of the institution, it was possible to identify the role of the Catholic Church in the foundation of the hospital, understand the economic interests of the founders of the hospital by defending the coffee elite of São Paulo from the complaints of mistreatment of its workers and infer on the political motivations in maintaining an institution that was primarily in the care of trachoma patients.(AU)

Bats (Mammalia: Chiroptera) in urban-rural interfaces: community structure associated with pathogen screening in São Paulo-the largest metropolitan region in Brazil.

Little is known about the influence of the urban environments on bat species 'ecology. The urbanization process potentially lead to critical ecological changes in bat communities' intra and interspecific pathogenic transmissions dynamics. To date, the monitoring of pathogens in bats in Brazil has only been done with bats found dead or alive in households, from rabies surveillance systems. The present work aimed to investigate how urbanization influenced bat richness, relative abundance and pathogen occurrence. Most captured bats were Phyllostomidae, especially Sturnira lilium, Artibeus lituratus, A. fimbriatus, Glossophaga soricina, and Platyrrhinus lineatus, among others. From preserved-rural towards urban areas the lesser the bat richness, the higher the relative abundance of the captured bats. Noise level, luminosity and relative humidity correlated with bat abundance. The proportion of genders, sexually active bats and their size (weight, right forearm length, and body condition index) were stable throughout the investigation. Still, the proportion of pregnant females was higher in Spring and the number of juveniles in Summer, evidencing the seasonality of reproduction. Several Enterobacteria were isolated, evidencing a significant role of bats in the circulation of pathogens of medical and veterinary interest. These results are crucial in the pursuit of a harmonious coexistence between humans, bats and domestic animals in areas with different levels of anthropization.

Spiritual needs among hospitalized patients at a public hospital in Brazil: a cross-sectional study

ABSTRACT BACKGROUND: The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE: This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING: A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS: The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS: A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION: Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.

Retrospective Insights of the COVID-19 Epidemic in the Major Latin American City, São Paulo, Southeastern Brazil.

São Paulo is the financial center of Brazil, with a population of over 12 million, that receives travelers from all over the world for business and tourism. It was the first city in Brazil to report a case of COVID-19 that rapidly spread across the city despite the implementation of the restriction measures. Despite many reports, much is still unknown regarding the genomic diversity and transmission dynamics of this virus in the city of São Paulo. Thus, in this study, we provide a retrospective overview of the COVID-19 epidemic in São Paulo City, Southeastern, Brazil, by generating a total of 9995 near-complete genome sequences from all the city's different macro-regions (North, West, Central, East, South, and Southeast). Our analysis revealed that multiple independent introduction events of different variants (mainly Gamma, Delta, and Omicron) occurred throughout time. Additionally, our estimates of viral movement within the different macro-regions further suggested that the East and the Southeast regions were the largest contributors to the Gamma and Delta viral exchanges to other regions. Meanwhile, the North region had a higher contribution to the dispersion of the Omicron variant. Together, our results reinforce the importance of increasing SARS-CoV-2 genomic monitoring within the city and the country to track the real-time evolution of the virus and to detect earlier any eventual emergency of new variants of concern that could undermine the fight against COVID-19 in Brazil and worldwide.

Bartonella spp. and Typhus Group Rickettsiae among Persons Experiencing Homelessness, São Paulo, Brazil.

Persons experiencing homelessness in São Paulo, Brazil, were seropositive for Bartonella spp. (79/109, 72.5%) and typhus group rickettsiae (40/109, 36.7%). Bartonella quintana DNA was detected in 17.1% (14/82) body louse pools and 0.9% (1/114) blood samples. Clinicians should consider vectorborne agents as potential causes of febrile syndromes in this population.

Neighborhood inequalities and the decline of infant mortality in São Paulo.

This paper documents changes in infant mortality (IM) rates in São Paulo, Brazil, between 2003 and 2013 and examines the association among neighborhood characteristics and IM. We investigate the extent to which increased use of health care services and improvements in economic and social conditions are associated with reductions in IM. Using data from the Brazilian Census and the São Paulo Secretaria Municipal da Saúde/SMS, we conducted a longitudinal analysis of panel data in all 96 districts of São Paulo for every year between 2003 and 2013. Our regression model includes district level measures that reflect economic, health care and social determinants of IM. We find that investments in health care have contributed to lower IM rates in the city, but the direct effect of increased spending is most evident for people living in São Paulo's middle- and high-income neighborhoods. Improvements in social conditions were more strongly associated with IM declines than increases in the use of health care among São Paulo's low-income neighborhoods. To reduce health inequalities, policies should target benefits to lower-income neighborhoods. Subsequent research should document the consequences of recent changes in Brazil's economic capacity and commitment to public health spending for population health.

Os Cerests como construtores de conhecimentos na pandemia de COVID-19: análise das ações realizadas no estado de São Paulo/Brasil / Cerests as knowledge builders in the COVID-19 pandemic: analysis of actions carried out in the state of São Paulo/Brazil

O presente artigo tem como objetivo relatar as experiências, ações e a construção de conhecimentos dos Centros de Referência em Saúde do Trabalhador (Cerests) inseridos no Estado de São Paulo durante o período de pandemia do COVID-19. É importante destacar que os Cerests estão inseridos em uma Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast). Sendo assim, foi realizado um levantamento entre os Cerests que possuem site, blog ou redes sociais e, e com isso, foi utilizado o método explanatório sequencial, nas informações coletadas, sistematizadas e analisadas sobre os conhecimentos construídos e as suas ações realizadas em educação, vigilância e assistência. Os resultados obtidos foram analisados à luz da literatura disponível que versa sobre a construção de conhecimento, saúde do trabalhador e sobre as ações realizadas no Estado de São Paulo frente à pandemia do COVID-19. O trabalho conclui-se com importantes reflexões da importância do conhecimento construído dentro de uma síntese com as ações identificadas nos Cerests, observando assim, que ações em sua maioria seguem diretrizes educativas e são balizadas pelo conhecimento. Essa síntese demonstra os conhecimentos construídos no período de pandemia, sendo estes norteadores para os demais Cerests frente à pandemia, e utilizadas no processo pós-pandemia(AU)

The objective of this article is to report the experiences, actions and knowledge construction of the Healthcare Reference Centers of Workers (in Portuguese Cerests) inserted in the State of São Paulo during the period of the COVID-19 pandemic. It is important to note that the Cerests are inserted in a National Network of Comprehensive Health Care for Workers (in Portuguese Renast). Thus, a survey was carried out among the Cerests who have a site, blog or social networks and, with it, the sequential explanatory method was used, the information collected, systematized and analyzed on the knowledge built and their actions carried out in education, vigilance and assistance. The results obtained are analyzed in light of the available literature that deals with the construction of knowledge, the health of the worker and on the actions carried out in the State of São Paulo in the face of the COVID-19 pandemic. The work was concluded with important reflections on the importance of the knowledge built within a summary of the actions identified by the Cerests, thus observing that most of them follow educational guidelines and are marked by knowledge. This summary demonstrates the ingredients built during the pandemic period, these being guides for the other Cerests in the face of the pandemic, and used in the post-pandemic process(AU)

Este artículo tiene como objetivo relatar las experiencias, acciones y construcción de conocimiento de los Centros de Referencia en Salud del Trabajador (en Portugués Cerests) insertos en el Estado de São Paulo durante el período de la pandemia de COVID-19. Es importante resaltar que los Cerests están insertos en una Red Nacional de Atención Integral a la Salud del Trabajador (en Portugués Renast). Por ello, se realizó una encuesta entre los Cerests que cuentan con sitio web, blog o redes sociales y, con ello, se utilizó el método explicativo secuencial, en la información recolectada, sistematizada y analizada sobre el conocimiento construido y sus acciones realizadas en educación, vigilancia y asistencia. Los resultados obtenidos fueron analizados a la luz de la literatura disponible que trata sobre la construcción del conocimiento, la salud de los trabajadores y las acciones realizadas en el Estado de São Paulo frente a la pandemia de la COVID-19. El trabajo concluye con importantes reflexiones sobre la importancia del saber construido en síntesis con las acciones identificadas en el Cerests, constatando así que la mayoría de las acciones siguen orientaciones educativas y son guiadas por el saber. Esta síntesis demuestra los conocimientos construidos durante el período de la pandemia, que son lineamientos para los demás Cerests frente a la pandemia, y utilizados en el proceso pospandemia(AU)